Real-World Molecular Testing and Treatment Patterns in Brazilian Patients with Newly Diagnosed Locally Advanced or Metastatic NSCLC

Abstract

To evaluate the molecular testing and treatment patterns in a retrospective cohort of newly diagnosed treatment-naïve patients with locally advanced or metastatic non-small-cell lung cancer (NSCLC). METHODS: This is an observational retrospective cohort study conducted across 10 cancer centers in Brazil. Treatment-naïve patients with locally advanced or metastatic NSCLC were enrolled from January to December 2014. The following data were collected from the medical records of patients from diagnosis until the last record (death, loss to follow-up, or the end of the maximum follow-up period): demographics; medical history; smoking status; disease characteristics; previous treatments; and molecular testing patterns and results. The overall survival (OS) was also estimated. Results: A total of 391 patients from 8 different Brazilian states were included, with a median age of 64.1 years (23.7-98.7), with most patients being males (60.1%). The smoking status of 74.2% of patients was a 'former' or 'current smoker'. Stage IV NSCLC at diagnosis was observed in 82.4% of patients, with 269 of them (68.8%) presenting adenocarcinoma (ADC). Among the stage IV ADC patients, 54.0% were referred for molecular testing. Among the patients with an available epidermal growth factor receptor (EGFR) mutation status, 31 (24.0%) were EGFR-positive. The first-line treatment was a platinum-based chemotherapy for 98 patients (25.1%), while nonplatinum-based regimens were used in 54 patients (13.8%). OS data were available for 370 patients, with a median OS of 10.8 months. Never smokers had a significantly higher median OS versus current or former smokers (14.6 versus 9.1 months; log-rank p=0.003). Among the patients for whom molecular testing data were available, those with EGFR-positive results had a longer median OS (34.6 versus 12.8 months; log-rank p=0.003). Conclusion: Our findings provide relevant information for prescribers and policy decision-makers by highlighting the unmet needs of patients and the importance of molecular testing in newly diagnosed locally advanced or metastatic lung adenocarcinoma. We also highlight the respective EGFR-tyrosine kinase inhibitor treatment when the result is positive and the areas in which further efforts are required to grant access to effective treatment.

Molecular patterns of egyptian patients with non-squamous non-small-cell lung cancers: a clinicopathological study

“…As expected, this was significantly worse than those who received any TKI during the therapy course (median: not reached, p < 0.001). This is consistent with almost every similar study denoting the importance of offering mutation-guided therapy as early as possible during the disease course [17][18][19]. Subsequently, the lack of molecular testing in stage IV nonsquamous NSCLC may be associated with a shorter OS.…”

Survival analysis of young adults from a Brazilian cohort of non-small cell lung cancer patients

“…In Brazil, data from a retrospective cohort study from the year 2014 indicate that around 50% of patients with metastatic adenocarcinoma were referred for molecular testing, among whom, 24% had a tumour with positive EGFR activating mutation and 87% received an EGFR-tyrosine kinase inhibitor. Patients harbouring EGFR mutation positive tumours had a longer median overall survival; however, it was not possible to individualise outcomes, according to patient age [22]. In this study, even though most of the patients were treated in the public health system, availability of target therapy is rather variable along the country to the present date.…”

Assessing Oncologists’ Attitudes Concerning Comprehensive Genomic Profiling in Stage IV Lung Adenocarcinoma in Brazil

“… 23 Cronemberger et al. 6 reported that only approximately 54% of LUAD were tested for EGFR mutation in 2014 in Brazil; frequencies of testing were significantly lower for patients in the public health system (70% versus 52%). Thus, oncologists’ perceptions of the testing value to these patients individually are low.…”

“…They also state that CGP should be considered for squamous cell histology, especially for never smokers. 3 , 4 , 5 , 6 Testing results should be available before initiating systemic therapy to guide first-line treatment properly. As of this writing, the Food and Drug Administration has approved targeted therapies for EGFR , ALK , ROS1 , KRAS G12C , BRAF V600E , MET , RET , and NTRK alterations; thus, LUAD samples should ideally have this minimum of eight genes appropriately sequenced.…”